How Toe Extend - The Great Big Toe!

If the function of your Big Toe (Great Hallux) is compromised, so is the rest of you!

When someone comes to me for an Anatomy in Motion consultation, one of the first things I look at is the ability to extend the Big Toe. It can tell you so much - How the foot will pronate and supinate, the ability to toe off, the chances of a clean heel strike and whether the hip and spine will be able to extend properly. With Anatomy in Motion, you can map all of the muscles on top of this and you have a lot of information walking around. 

TEST: Standing with your legs shoulder width apart, lift your toes up as far as you can without transferring your weight into your heels. Can you get 60 degrees?

This week, there was a client reporting pain on the medial (inside) gastrocnemius (calf), right lower back tightness and limited hip mobility. There was a long injury history, most notably:

  • Numerous ankle sprains and ligament damage to the right ankle.
  • Left hamstring tear.
  • Right meniscus tear.  

I'd received a health & injury history form the day before the consultation so had already started to build a picture of what could be going on.

On Assessment we found:

  1. Decreased Big Toe extension, worse on the right. 
  2. Both feet maintained a pronated foot posture throughout the gait cycle meaning both calcaneus (heel bone) stayed everted - Thus, no supination present. 
  3. There was a timing issue with Shift & Strike Phases of Gait.
  4. The right foot was more pronated than the left and the right hip was hiked so the pelvis had difficulty shifting to the left. 

Thought Process:

When I meet clients, I like to figure out why their body has set itself up the way it has to manage its mass and get from A to B. This helps build a picture of what's going on and identify the compensation patterns.

From the Big Toe extension test, I knew they could not achieve the optimal 60 degree active extension. Even before seeing the client move, I knew the windlass mechanism would be affected. The windlass mechanism is simply the tightening of the fascia on the bottom of your foot as you push-off. As it tightens, it acts to stop your foot collapsing by supporting your arch and helps propel you forward. A very important relationship in human movement is Big Toe extension coupled with same side hip extension. Without this 60 degrees we may never fully extend our hip, which leads to compensation patterns. This might explain why the right hip remained hiked and the right side of the back was sore. 

Having both feet everted meant the talus, the driver of the bus, was stuck everted and internally rotated so we have no supination mechanics in the rearfoot. The knock on effect limits the ability of the hips to externally rotate, the Psoas to lengthen during toe off and spinal rotation the entire way to the neck. 

Observing the client walk, there was a timing issue with Shift & Strike Phase of Gait. Shifting the pelvis to the left in particular was an issue. Rule one of the Five Big Rules in the book 'What The Foot' by Gary Ward, creator of Anatomy in Motion - 'Muscles Lengthen Before They Contract'. Knowing this, when shifting the pelvis to the left the right medial calf should be eccentrically lengthened IF the correct foot mechanics were in place. And guess what foot mechanics were missing - 'supination'. Without supination, there is no way for the muscle to lengthen. The client having pain in the right medial calf was no surprise, the muscle was dormant.

Additional to this, the client was given orthotics a few months ago and had mentioned their back had started getting sore as soon as they started wearing the orthotics. Orthotics are very popular, I see clients daily with them. My question is: Why do you wear them? When you place insoles into your footwear, you are restricting your feet from moving. It stops your feet from doing the thing it is naturally designed to do - Move! 66 joints over two feet and you are going to stop it from moving? Really? Insoles dictate the mechanics in your foot, which then transfers into your walking. It changes how you body manages its mass and often just shifts the problem to another part of the body. 

So now we have feet that don't supinate, calves that cannot lengthen and a windlass mechanism that might as well be asleep with no help from the shackles of Mr Orthotic.

The picture was starting to take shape.  

We weren't out of the woods just yet...

I noticed as soon as the client would start walking they would shrug their shoulders and extend their head back. The client did not notice they were doing it until I showed them on the slow motion camera. This fascinated me, I wanted to know why. Where did it fit into the story? Their body was doing this for a reason.

I mimicked the client's posture in my own body and copied the shrug of the shoulders and extending my head back to see how it felt. One of the roles of the windlass mechanism is to extend the big toe as the leg swings through. When this wasn't happening for the client they had to increase hip flexion to bring the foot higher off the ground, again agitating the lower back.  

Once I experienced the movement in my own body, I understood what the client's body was doing. It is so unbelievably clever how our bodies will make adaptations to keep us moving. What was happening was the client's brain was looking for a way to create some form of active windlass mechanism as it was not happening in the feet. Shrugging the shoulders and extending the head back was the most optimal way for the client's body to attempt to load the extensor chain. If you extend the head back without the shoulder shrug you get less extension, so adding the shrug of the shoulder is genius (A retraction of the jaw may have also added further extension). 

Once analysis was finished, the treatment was straight forward. Using Anatomy in Motion wedges, we performed some big toe extension movements to wake up the sleepy windlass mechanism. This levelled the pelvis, yet the foot postures had not changed. Knowing the client's brain was already trying to create an active windlass with the head extension, I introduced strike phase of gait. After a few repetitions, I asked the client to go for a walk to see what adjustments their body would do with this newly integrated movement. Once the client started walking they no longer shrugged their shoulders or extended their head back.

The body was beginning to re-organise itself once shown a better option. 

Now it was time to get the tripod of the foot on the ground and offer the brain an experience of pronation and supination mechanics. Transition phase of gait was the main focus here to provide an experience of inversion and external rotation in the rearfoot and encourage supination. 

Now with an experience of how feet should move naturally we introduced a movement that would allow the pelvis to shift over to the left and eccentrically lengthen the right medial calf, wake it up and remind it of the job it has to do. 

At the end of the session, the orthotics were thrown in the bin, the right medial calf pain had reduced to a 2/10, lower back pain was gone and their body felt looser and more balanced. There is still work to do. Calves are tough muscles to work with, we spend all day upright and very often the calves take the brunt of it. 

I then gave them homework consisting in 2 simple exercises: A supination movement to continue to develop movement of the feet and a shift movement with a focus on eccentrically lengthening the right calf. The responsibility is over to the client to continue implementing these new movements into their body. I look forward to the next session where quite often we can be dealing with a completely different body.  

Don't underestimate the effects of a stubbed or broken toe and its contribution to the pain you're experiencing anywhere in your body. 

The correct movement of the 33 joints in each foot is CRUCIAL to how the rest of the body moves and functions. In a perfectly flowing gait cycle every joint in the body has the ability to access 3 planes of movement, in 7 phases of gait, all happening in under 0.85seconds! 

If you have done the test at the start of the blog, did you achieve Big Toe extension of 60 degrees? It may give you some insight to what's going on in your body.

If you'd like to learn more about the Windlass Mechanism, you can watch this VIDEO.

To get in touch with me, press the button below: 

All the best,

Anthony Claffey

I leave you with these wise words from Mr. Gary Ward:

The Great Hallux (a small rant)

If I can’t extend my toe, my heel strike will be compromised
If I can’t extend my toe, my toe off will be compromised.
If I can’t extend my toe, my pronation phase will be compromised
If I can’t extend my toe, to resupinate becomes impossible
If I can’t extend my toe, my hip extension will be compromised
If I can’t extend my toe, my spinal extension will be compromised
and if I can extend my toe waaaay too much, all of the above still stands true…

Please don’t lock it in tight fitting shoes or wear flipflops or surgically intervene to make it more stable goddammitt !!!!!!
— Gary Ward creator of Anatomy in Motion
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